Examinando por Materia "Autopsy"
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Publicación Acceso abierto Comments to: A systematic review of pathological findings in COVID-19: a pathophysiological timeline and possible mechanisms of disease progression(Nature Pub. Grupo, 2020-07) Parra Medina, Rafael; Herrera, Sabrina; Mejía, JaimeWe reviewed the excellent systematic article published by Pola et al. [1] about the pathological findings in COVID-19. Based on the 250 COVID-19 autopsies found during our systematic review through March 30, 2020; we concur with the article hypothesis of mechanisms of infection and the tissular injury. However, we would like to highlight two topics that the authors did not discuss. The first, the autopsies findings could support the hypothesis of macrophages hyperactivation. This has already been reported in other coronavirus such as SARS-CoV1 and MERS [2]. In the initial autopsies in COVID-19 patients, the presence of CD68+ macrophages in lung and heart tissues [3, 4] and the presence of CD169+ macrophages in lymph node subcapsular spaces and in splenic marginal zone were reported. These macrophages expressed the SARS-CoV-2 entry receptor ACE2 and contained SARS-CoV-2 nucleoprotein [5]. Disorders of macrophages as secondary hemophagocytic lymphohistiocytosis (sHLH) have been reported in COVID-19 . In autopsies, hemophagocytosis has been observed in lung, lymph node, bone marrow, liver, and spleen . sHLH is a hyperinflammatory syndrome characterized by a fulminant and fatal hypercytokinaemia with multiorgan failure. In adults, sHLH is mostly triggeredby viral infections, autoimmune diseases and neoplasms [11], and occurs in 3.7–4.3% of sepsis cases [12]. The diagnosis of sHLH is based on clinical, laboratory, and morphologic criteria. The main features are: unremitting fever, cytopenias, hepatosplenomegaly, hypertriglyceridemia, hypofibrinogenemia, and hyperferritinemia. Severe COVID-19 could be considered a hyperferritinemic syndrome by the clinical similarities detected . In these conditions, Ferritin plays a critical role in the immune response. The production and secretion of extracellular ferritin is derived from macrophages.Publicación Acceso abierto Review of clinical non-medico-legal autopsy: a descriptive study in 747 patients(Autoridad de Medicina Forense de Egipto, 2018-12) Mendoza, Oscar; Bonilla, Juan Carlos; Moreno, Liliana; Piedrahita, Carolina; Mosquera, Andrés; Parra Medina, RafaelBackground: Autopsies have been an essential element to healthcare professionals’ training, as well as to research processes, education, and public health. In spite of the decline of clinical autopsy rate after the Joint Commission on the Accreditation of Hospitals eliminated the minimum autopsy rate required for accrediting hospitals, in Colombia, South America, we have seen that this practice has been reinitiated and our institution has performed more than 200 autopsies per year. Objective: To describe the main causes of death among individuals to whom a clinical autopsy was practiced at a general hospital in Bogotá, Colombia. Methods: A descriptive study of autopsy reports during the period between January 2012 and June 2015 was conducted. Results: The study included 747 autopsies of which 58.2% were performed in males. The majority of deaths occurred among the 41 to 64 years (mean 32.53, SD 28.53) age group. The leading cause of death observed in young adults and middle-aged adults (18 to 64 years) was cardiac arrest (58.5%) associated with acute myocardial infarction, cardiomyopathies, or cardiovascular abnormalities, followed by respiratory conditions (42.6%) and cardiac sudden death as the second cause of death in young adults. Conclusions: Studies based on clinical autopsies allow precise knowledge on the main underlying causes of death in a population, as well as, enable ideas based on key data obtained to be used in the development of cardiovascular prevention strategies for the different age groups thus preventing fatal outcomes in young adults who are the active working, productive population in society.